International journal of medical research and review, Jan 31, 2016
Introduction: Carcinoma cervix is one of the leading causes of morbidity and mortality. The most ... more Introduction: Carcinoma cervix is one of the leading causes of morbidity and mortality. The most effective method of screening is based on Pap smear study. However, Pap smear has relatively low sensitivity and irreducible false negative & false positive rates. In countries like India, it is not always feasible to follow the patient for confirmation by histology. In the present study, we have tried to fill this gap by staining the cervical smears with, epithelial cell markers including CK17 and CEA expressed by dysplastic squamous cells. Materials & Methods: 50 cervical smears reported as precancerous or cancerous were stained with anti CK17 and anti CEA. The patients were followed for histopathology. Results: Out of 20 cases of ASCUS, three were positive both for anti-CK17 and anti-CEA and six were positive for anti-CK17 only. Out of 18 cases of LSIL, nine were positive for both anti-CK17 and anti-CEA and fifteen were positive for anti-CK17 only. Out of eight cases of HSIL, three were positive for both anti-CK17 and anti-CEA and six were positive for anti-CK17 only. Out of 4 cases of SCC, three were positive for both anti-CK17 and anti-CEA and all four were positive for anti-CK17. Conclusion: Positive result in staining was higher in high grade lesions. CK 17 was found to be better marker than CEA. CK17 and CEA can be used as adjunct to Pap smear screening but its high cost may restrict its use in routine.
We have developed and evaluated a polymerase chain reaction (PCR) assay suitable for the detectio... more We have developed and evaluated a polymerase chain reaction (PCR) assay suitable for the detection of Mycobacterium tuberculosis DNA from fine needle aspirate smears of patients with tuberculous lymphadenitis. Air-dried fine needle aspirates of cervical lymph nodes from 98 patients with tuberculous lymphadenitis were studied for cytomorphology, detection of acid fast bacilli by Ziehl-Neelsen staining, culture and nested PCR with IS6110 for mycobacteria on DNA eluted from the dried unstained cytology smear. Twenty aspirate smears with diseases other than tuberculosis were similarly tested as controls. Mycobacterial-DNA was amplified by PCR in 84 (85%) cases and in 1 (5%) control. The mycobacteria could be detected by Ziehl-Neelsen stain and culture in 15 (15.3%) and 24 (24.4%) cases, respectively, whereas both tests were negative in controls. When results were compared with nested PCR on DNA from biopsies from the same case as the gold standard, the sensitivity, specificity, positive and negative predictive values of smear PCR were 85%, 95%, 96%, and 59%, respectively. In conclusion, PCR using dried cytology smear material is feasible and is a simple and sensitive technique for an early and specific diagnosis of M. tuberculosis complex. This is particularly useful when cytology is equivocal and can obviate the use of more invasive procedures.
Introduction: Lung malignancy is one of the most common neoplasms worldwide. Accurate histology s... more Introduction: Lung malignancy is one of the most common neoplasms worldwide. Accurate histology sub-typing and identification of gene mutations in lung tumours are considered important to administer targeted therapy for improved clinical outcome. Our aim is to determine the frequency of EGFR mutation and Programmed death ligand-1 (PD-L1) status of lung malignancies in patients attending a rural hospital in Central India. Materials and methods: Formalin-fixed histology diagnosed lung malignancy (n=99) bronchoscopic/trucut lung biopsies were identified and the tissue blocks and slides were retrieved. Histology typing and staging of the lesions was assessed. PD-L1 expression on biopsy was detected by immunohistochemistry using commercially available primary antibody. PD-L1 expression was assessed and semi-quantified based on the intensity and proportion of tumour cells stained for the marker. EGFR gene mutation at exon19 and 21 was detected by polymerase chain reaction of tissue from paraffin blocks. Final analysis was performed on 87 biopsies for status of EGFR mutation and PD-L1 expression. Results: The average age of lung malignancies patients was 63 years, with a preponderance of males. Advance disease in stage III and stage IV was more common in squamous cell carcinoma as compared to adenocarcinoma (p < 0.01). Mutations at exon 19-21 of the EGFR gene were detected in 7/87 (8%) cases of adenocarcinoma and all of these patients were non-smokers. A total of 52.9% of biopsies showed PD-L1 expression, which was higher in adenocarcinoma patients (p=0.04), smokers (p=0.00), and stage II and III patients (p= 0.00). Conclusion: EGFR gene mutations at exon 19 or 21 are seen in lung adenocarcinoma cases. PD-L1 expression was observed in EGFR mutated tissues. Our results should be further validated with large sample size and multicenter clinical data before extrapolation to design immunotherapy strategies.
Background: The health implications surrounding a mass gathering pose significant challenges to p... more Background: The health implications surrounding a mass gathering pose significant challenges to public health officials. The use of syndromic surveillance provides an ideal method for achieving the public health goals and objectives at such events. In the absence of published reports of systematic documentation of public health preparedness in mass gatherings in the local context, we describe the public health preparedness and demonstrate the operational feasibility of a tablet-based participatory syndromic surveillance among pilgrims during the annual ritual circumambulation-Panchkroshi Yatra. Methods: A real-time surveillance system was established from 2017-2019 to capture all the health consultations done at the designated points (medical camps) in the Panchkroshi yatra area of the city Ujjain in Madhya Pradesh. We also surveyed a subset of pilgrims in 2017 to gauge satisfaction with the public health measures such as sanitation, water, safety, food, and cleanliness. Results: In 2019, injuries were reported in the highest proportion (16.7%; 794/4744); most numbers of fever cases (10.6%; 598/5600) were reported in 2018, while 2017 saw the highest number of patient presentations of abdominal pain (7.73%; 498/6435). Conclusion: Public health and safety measures were satisfactory except for the need for setting up urinals along the fixed route of the circumambulation. A systematic data collection of selected symptoms among yatris and their surveillance through tablet could be established during the panchkroshi yatra, which can complement the existing surveillance for detecting early warning signals. We recommend the implementation of such tablet-based surveillance during such mass gathering events.
Background: The aim of this study was to evaluate the diagnostic potential of immunohistochemistr... more Background: The aim of this study was to evaluate the diagnostic potential of immunohistochemistry using an antibody to the secreted mycobacterial antigen MPT64, in abdominal and lymph node tuberculosis. Methods: We used formalin-fixed histologically diagnosed abdominal tuberculosis (n = 33) and cervical tuberculous lymphadenitis (n = 120) biopsies. These were investigated using a combination of Ziehl-Neelsen method, culture, immunohistochemistry with an antibody to MPT64, a specific antigen for Mycobacterium tuberculosis complex organisms. Abdominal and cervical lymph node biopsies from non-mycobacterial diseases (n = 50) were similarly tested as negative controls. Immunohistochemistry with commercially available anti-BCG and nested PCR for IS6110 were done for comparison. Nested PCR was positive in 86.3% cases and the results of all the tests were compared using nested PCR as the gold standard. Results: In lymph node biopsies, immunohistochemistry with anti-MPT64 was positive in 96 (80%) cases and 4 (12.5%) controls and with anti-BCG 92 (76.6%), and 9 (28%) respectively. The results for cases and controls in abdominal biopsies were 25 (75.7%) and 2 (11.1%) for anti-MPT64 and 25 (75.7%) and 4 (22%) for anti-BCG. The overall sensitivity, specificity, positive and negative predictive values of immunohistochemistry with anti-MPT64 was 92%, 97%, 98%, and 85%, respectively while the corresponding values for anti-BCG were 88%, 85%, 92%, and 78%. Conclusion: Immunohistochemistry using anti-MPT64 is a simple and sensitive technique for establishing an early and specific diagnosis of M. tuberculosis infection and one that can easily be incorporated into routine histopathology laboratories.
Background: The global expansion of antibiotic-resistant bacteria is a serious concern and is inc... more Background: The global expansion of antibiotic-resistant bacteria is a serious concern and is increasing worldwide in both pathogenic and commensal bacteria. The study determined the correlation between individual child-level antibiotic consumption and antibiotic resistance among the commensal Escherichia coli (E.coli) in a cohort of 125 children in rural Ujjain, India. Methods: During a two-year period between August 2014 and September 2016, stool samples were collected at seven-time points from a cohort of 125 children; aged 1-3. A total of six colonies of E.coli per stool sample were collected for antibiotic susceptibility testing. Antibiotic consumption data was collected during the healthcare-seeking follow-up done during the same period. At each of the seven-time points correlation between antibiotic consumption (Defined Daily Dose-DDD/100 patient-days) and antibiotic resistance (number of resistant isolates) was analyzed independently using the Spearman correlation coefficient. Further, mixed-effects logistic regression models were built to study correlation between child-level consumption of penicillin with the number of E.coli isolates resistant to ampicillin, consumption of cephalosporin with resistance to cefotaxime and ceftazidime, consumption of fluoroquinolones with resistance to nalidixic acid and consumption of cotrimoxazole with resistance to cotrimoxazole. Results: Out of 756 illness episodes reported in 125 children 42% were with antibiotic prescriptions and reported a total antibiotic consumption of 55DDD/100 patient-days. The most common antibiotics used were cefixime (J01DD08;72 DDD/100patient/days) followed by ofloxacin (J01MA01;51DDD/100patient-days), cefpodoxime (J01DD13;38DDD/100patient-days) and amoxicillin (J01CA04;28DDD/100patient-days). The highest percentage of resistance was found to the ampicillin (67%) followed by nalidixic acid (52%) and cefotaxime (44%) and when summarized, more than 90% were resistant to cefotaxime, ceftazidime, and cotrimoxazole in commensal E.coli isolates. The consumption of cephalosporins showed weak positive correlation with the resistance to cefotaxime (Coefficient±SE=0.13 ± 0.09,p<0.001). Conclusion: Our findings showed no correlation between individual-level antibiotic consumption and resistance development in commensal E.coli in a rural community environment.
International Journal of Environmental Research and Public Health, Jun 15, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background: Segregation of household waste at the source is an effective and sustainable strategy... more Background: Segregation of household waste at the source is an effective and sustainable strategy for management of municipal waste. However, household segregation levels remain insufficient as waste management approaches are mostly top down and lack local support. The realisation and recognition of effective, improved and adequate waste management may be one of the vital drivers for attaining environmental protection and improved health and well-being. The presence of a local level motivator may promote household waste segregation and ultimately pro-environmental behaviour. The present cluster randomized control trial aims to understand if volunteer based information on waste segregation (I-MISS) can effectively promote increased waste segregation practices at the household level when compared with existing routine waste segregation information in an urban Indian setting.
The Internet journal of ophthalmology & visual science, 2009
Introduction: Mycotic ulcer is common in rural, remote, agricultural regions of India, where prim... more Introduction: Mycotic ulcer is common in rural, remote, agricultural regions of India, where primary medical facilities are lacking. Diagnosis of causative fungus is usually not possible on the basis of available clinical and laboratory tests so the magnitude of mycotic keratitis is underestimated as a factor of corneal blindness. Purpose: To know the incidence of mycotic keratitis among the all corneal blindness cases along with predisposing factors, Setup: Tertiary Care Center (Medical college hospital). Material and Methods: We have included in the present study 201 consecutive cases of corneal ulcer attended hospital during April 2006 to November 2007. Diagnosis of mycotic keratitis was confirmed by history, clinical examination, direct microscopic examination of corneal scraping from the edge of ulcer for fungal hyphae and culture of fungus of corneal scraping and pus from anterior chamber, in different culture medias. Results: 42 cases (20.9%) of fungal corneal ulcer were found to be positive by direct examination and / or by culture. Fungal hyphae were seen by wet mount KOH preparation in 34 (80.9%) and culture growth present in 37 (88.0%) cases. Patients who have both test positive were 31(73.8%). Out of 34 culture grown 23 (54.7%) had pure fungal growth while 14(45.3%) showed fungus with superadded bacterial infections. Aspergillus fumigatus was the commonest causal agent isolated from 12 cases (5.9%) followed by in order to frequency are Aspergillus flavus (3.9 %), Candida (4.48 %), Curvularia (2.98 %), Penicillium (2.49 %) and Fusarium species (1.0 %). Conclusion: This study suggests that in all cases of corneal ulcer, corneal scraping is mandatory for early diagnosis of mycotic keratitis to prevent corneal blindness as there is a high incidence (20.9%) particularly in tropical agricultural regions.
et al. Determinants and pathways of healthcareseeking behaviours in under-5 children for common c... more et al. Determinants and pathways of healthcareseeking behaviours in under-5 children for common childhood illnesses and antibiotic prescribing: a cohort study in rural India. BMJ Open 2021;11:e052435.
International Journal of Environmental Research and Public Health, Apr 6, 2017
Antibiotic-resistant bacteria are an escalating grim menace to global public health. Our aim is t... more Antibiotic-resistant bacteria are an escalating grim menace to global public health. Our aim is to phenotype and genotype antibiotic-resistant commensal Escherichia coli (E. coli) from humans, animals, and water from the same community with a 'one-health' approach. The samples were collected from a village belonging to demographic surveillance site of Ruxmaniben Deepchand (R.D.) Gardi Medical College Ujjain, Central India. Commensal coliforms from stool samples from children aged 1-3 years and their environment (animals, drinking water from children's households, common source-and waste-water) were studied for antibiotic susceptibility and plasmid-encoded resistance genes. E. coli isolates from human (n = 127), animal (n = 21), waste-(n = 12), source-(n = 10), and household drinking water (n = 122) carried 70%, 29%, 41%, 30%, and 30% multi-drug resistance, respectively. Extended spectrum beta-lactamase (ESBL) producers were 57% in human and 23% in environmental isolates. Co-resistance was frequent in penicillin, cephalosporin, and quinolone. Antibiotic-resistance genes bla CTX-M-9 and qnrS were most frequent. Group D-type isolates with resistance genes were mainly from humans and wastewater. Colistin resistance, or the mcr-1 gene, was not detected. The frequency of resistance, co-resistance, and resistant genes are high and similar in coliforms from humans and their environment. This emphasizes the need to mitigate antibiotic resistance with a 'one-health' approach.
Background: Brucellosis is the most common zoonotic disease caused by Gram-negative coccobacillus... more Background: Brucellosis is the most common zoonotic disease caused by Gram-negative coccobacillus belonging to genus Brucella. It is a recognized public health problem in developing countries including India. Aims and Objectives: The aims of these study were to determine the seroprevalance of brucellosis in population having occupation dealing with animals and thus are in close contact of animals. Materials and Methods: The study was conducted in semi-urban areas of central India. Blood samples were collected from personnel working in slaughter houses, meat shops, and veterinarians and their close contact and who are willing to participate in study. A total 102 samples collected randomly from butchers (n=20), veterinarians (n=29), and animal handlers (n=53) and were tested for Brucella abortus and Brucella melitensis by a commercial kit which allows the detection of both complete (IgG and IGM) and incomplete antibodies. Results: A total 102 subjects were included in the study and overall prevalence of brucellosis among high-risk group was found to be 2.9%. One veterinarian doctor was also found positive for both B. melitensis and B. abortus. Highest prevalence of brucellosis was found in veterinarians (6.8%) followed by animal handlers (1.8%), and none of the butcher was tested positive for any of the Brucella antibody. Conclusion: The present study screened all possible known high-risk groups for brucellosis and revealed that veterinarians have high chances of getting the infection. Occupation-related disease like brucellosis needs regular surveillance and integration into control and prevention program at a local and national level.
Increasing generation of wastewater and its indiscriminate disposal is detrimental to human and a... more Increasing generation of wastewater and its indiscriminate disposal is detrimental to human and animal health. Resource‐limited settings often struggle for efficient wastewater treatment systems owing to lack of funds and operational difficulties. Therefore, alternative treatment systems involving low expenditure and simplistic operations are need of the hour. Constructed wetlands are one such alternative that can efficiently remove variety of pollutants from wastewater. In this study, we have assessed the utility of constructed wetlands for treatment of hospital wastewater in Ujjain. An in‐house wetland system was designed and constructed using Typha latifolia and Phragmites karka. Results showed that wetland was efficient for removal of various physico‐chemical and biological contaminants, namely, biochemical‐oxygen‐demand (77.1%), chemical‐oxygen‐demand (64.9%), turbidity (68.3%), suspended‐solids (63%), total‐phosphorus (58.7%), nitrate‐nitrogen (33%), fecal coliforms (96.8%), and total coliforms (95.6%). Paired t test revealed that removal efficiencies for various parameters were significantly different among Phragmites, Typha, and control cells (p ≤ 0.05). Study also depicted that most of the bacterial isolates in inlet wastewater were selectively resistant to antibiotics (ciprofloxacin and sulphamethaxazole) as well and these isolates were also removed. Precisely, Typha was fairly suitable for antibiotic resistant bacteria removal. Thus, constructed wetlands were found to be one of the suitable options for wastewater treatment in resource‐limited settings.Practitioner Points Constructed wetlands are one of the suitable options for wastewater treatment in resource limited settings. These systems involve wetland vegetation, soil, and associated microbial assemblages to improve the water quality. Typha and Phragmites were found to be efficient for treating the hospital wastewater. Experiments showed that antibiotic resistant bacteria may also be removed through constructed wetland systems. Easy operation, cost effectiveness, and efficiency are important attributes.
Background Antibiotic resistance is one of the major global health emergencies. One potential sou... more Background Antibiotic resistance is one of the major global health emergencies. One potential source of dissemination of resistant bacteria is mass gatherings, e.g. mass bathing events. We evaluated the physicochemical parameters of water quality and the antibiotic resistance pattern in commensal Escherichia coli from river-water and river-sediment in pre-, during-and postmass bathing events in river Kshipra, Central India. Method/Design Water and sediment samples were collected from three selected points during eight mass bathing events during 2014-2016. Water quality parameters (physical, chemical and microbiological) were analyzed using standard methods. In river water and sediment samples, antibiotic susceptibility patterns of isolated E. coli to 17 antibiotics were tested. Results pH, turbidity and dissolved oxygen were significantly lower and total dissolved solid, free carbon dioxide were higher during mass bathing, whilst TSS, BOD and COD were lowest in pre-bathing and highest in post-bathing period. E.coli with multi drug resistance (MDR) or extended spectrum beta-lactamase (ESBL) production were between 9-44% and 6-24%, respectively in river-water as well as river-sediment. Total coliform count/ml and E. coli count were higher during-and post-bathing in river water than in pre-bathing period. Thus, the percentage of resistance was significantly higher during and post-bathing period (p<.05) than in pre-bathing. Colony forming unit (CFU)/ml in river-sediment was much higher than in
Background Artesunate plus sulfadoxine-pyrimethamine (ASP) are first line treatment for uncomplic... more Background Artesunate plus sulfadoxine-pyrimethamine (ASP) are first line treatment for uncomplicated Plasmodium falciparum malaria in most of India, except for six Northeastern provinces where treatment failure rates were high. In Ujjain, central India, the frequency of mutations associated with increased drug tolerance, but not overt resistance to sulfadoxine and pyrimathamine were 9% and >80%, respectively, in 2009 and 2010, just prior to the introduction of ASP. The frequency of drug resistance associated mutations in Ujjain in 2015-2016 after 3-4 years of ASP use, are reported. Methods Blood samples from patients with P. falciparum mono-infection verified by microscopy were collected on filter-paper at all nine major pathology laboratories in Ujjain city. Codons pfdhfr 16-185, pfdhps 436-632 and K13 407-689 were identified by sequencing. Pfcrt K76T and pfmdr1 N86Y were identified by restriction fragment length polymorphism. Results Sulfadoxine-pyrimethamine resistance-associated pfdhfr 108N and 59R alleles were found in 100/104 (96%) and 87/91 (96%) samples, respectively. Pfdhps 437G was found in 10/105 (10%) samples. Double mutant pfdhfr 59R+108N were found in 75/81 (93%) samples. Triple mutant pfdhfr 59R + 108N and pfdhps 437G were found in 6/78 (8%) samples. Chloroquine-resistance-associated pfcrt 76T was found in 102/102 (100%). Pfmdr1 N86 and 86Y were identified in 83/115 (72%) and 32/115 (28%) samples, respectively. Conclusion The frequency of P. falciparum with reduced susceptibility to sulfadoxine-pyrimethamine remained high but did not appear to have increased significantly since the introduction of ASP. No polymorphisms in K13 associated with decreased artemisinin susceptibility were found. ASP probably remained effective, supporting continued ASP use. Background Malaria caused an estimated 9.6 million infections and 16 700 deaths in India in 2017. Approximately 12% (163 million) and 81% (1.1 billion) of Indians live in high and low malaria transmission areas, respectively. Only 7% (88 million) live in areas considered to be malaria-free. Malaria thus remains a major cause of morbidity and mortality and threatens the majority of the population [1]. Moreover,
International journal of medical research and review, Jan 31, 2016
Introduction: Carcinoma cervix is one of the leading causes of morbidity and mortality. The most ... more Introduction: Carcinoma cervix is one of the leading causes of morbidity and mortality. The most effective method of screening is based on Pap smear study. However, Pap smear has relatively low sensitivity and irreducible false negative & false positive rates. In countries like India, it is not always feasible to follow the patient for confirmation by histology. In the present study, we have tried to fill this gap by staining the cervical smears with, epithelial cell markers including CK17 and CEA expressed by dysplastic squamous cells. Materials & Methods: 50 cervical smears reported as precancerous or cancerous were stained with anti CK17 and anti CEA. The patients were followed for histopathology. Results: Out of 20 cases of ASCUS, three were positive both for anti-CK17 and anti-CEA and six were positive for anti-CK17 only. Out of 18 cases of LSIL, nine were positive for both anti-CK17 and anti-CEA and fifteen were positive for anti-CK17 only. Out of eight cases of HSIL, three were positive for both anti-CK17 and anti-CEA and six were positive for anti-CK17 only. Out of 4 cases of SCC, three were positive for both anti-CK17 and anti-CEA and all four were positive for anti-CK17. Conclusion: Positive result in staining was higher in high grade lesions. CK 17 was found to be better marker than CEA. CK17 and CEA can be used as adjunct to Pap smear screening but its high cost may restrict its use in routine.
We have developed and evaluated a polymerase chain reaction (PCR) assay suitable for the detectio... more We have developed and evaluated a polymerase chain reaction (PCR) assay suitable for the detection of Mycobacterium tuberculosis DNA from fine needle aspirate smears of patients with tuberculous lymphadenitis. Air-dried fine needle aspirates of cervical lymph nodes from 98 patients with tuberculous lymphadenitis were studied for cytomorphology, detection of acid fast bacilli by Ziehl-Neelsen staining, culture and nested PCR with IS6110 for mycobacteria on DNA eluted from the dried unstained cytology smear. Twenty aspirate smears with diseases other than tuberculosis were similarly tested as controls. Mycobacterial-DNA was amplified by PCR in 84 (85%) cases and in 1 (5%) control. The mycobacteria could be detected by Ziehl-Neelsen stain and culture in 15 (15.3%) and 24 (24.4%) cases, respectively, whereas both tests were negative in controls. When results were compared with nested PCR on DNA from biopsies from the same case as the gold standard, the sensitivity, specificity, positive and negative predictive values of smear PCR were 85%, 95%, 96%, and 59%, respectively. In conclusion, PCR using dried cytology smear material is feasible and is a simple and sensitive technique for an early and specific diagnosis of M. tuberculosis complex. This is particularly useful when cytology is equivocal and can obviate the use of more invasive procedures.
Introduction: Lung malignancy is one of the most common neoplasms worldwide. Accurate histology s... more Introduction: Lung malignancy is one of the most common neoplasms worldwide. Accurate histology sub-typing and identification of gene mutations in lung tumours are considered important to administer targeted therapy for improved clinical outcome. Our aim is to determine the frequency of EGFR mutation and Programmed death ligand-1 (PD-L1) status of lung malignancies in patients attending a rural hospital in Central India. Materials and methods: Formalin-fixed histology diagnosed lung malignancy (n=99) bronchoscopic/trucut lung biopsies were identified and the tissue blocks and slides were retrieved. Histology typing and staging of the lesions was assessed. PD-L1 expression on biopsy was detected by immunohistochemistry using commercially available primary antibody. PD-L1 expression was assessed and semi-quantified based on the intensity and proportion of tumour cells stained for the marker. EGFR gene mutation at exon19 and 21 was detected by polymerase chain reaction of tissue from paraffin blocks. Final analysis was performed on 87 biopsies for status of EGFR mutation and PD-L1 expression. Results: The average age of lung malignancies patients was 63 years, with a preponderance of males. Advance disease in stage III and stage IV was more common in squamous cell carcinoma as compared to adenocarcinoma (p < 0.01). Mutations at exon 19-21 of the EGFR gene were detected in 7/87 (8%) cases of adenocarcinoma and all of these patients were non-smokers. A total of 52.9% of biopsies showed PD-L1 expression, which was higher in adenocarcinoma patients (p=0.04), smokers (p=0.00), and stage II and III patients (p= 0.00). Conclusion: EGFR gene mutations at exon 19 or 21 are seen in lung adenocarcinoma cases. PD-L1 expression was observed in EGFR mutated tissues. Our results should be further validated with large sample size and multicenter clinical data before extrapolation to design immunotherapy strategies.
Background: The health implications surrounding a mass gathering pose significant challenges to p... more Background: The health implications surrounding a mass gathering pose significant challenges to public health officials. The use of syndromic surveillance provides an ideal method for achieving the public health goals and objectives at such events. In the absence of published reports of systematic documentation of public health preparedness in mass gatherings in the local context, we describe the public health preparedness and demonstrate the operational feasibility of a tablet-based participatory syndromic surveillance among pilgrims during the annual ritual circumambulation-Panchkroshi Yatra. Methods: A real-time surveillance system was established from 2017-2019 to capture all the health consultations done at the designated points (medical camps) in the Panchkroshi yatra area of the city Ujjain in Madhya Pradesh. We also surveyed a subset of pilgrims in 2017 to gauge satisfaction with the public health measures such as sanitation, water, safety, food, and cleanliness. Results: In 2019, injuries were reported in the highest proportion (16.7%; 794/4744); most numbers of fever cases (10.6%; 598/5600) were reported in 2018, while 2017 saw the highest number of patient presentations of abdominal pain (7.73%; 498/6435). Conclusion: Public health and safety measures were satisfactory except for the need for setting up urinals along the fixed route of the circumambulation. A systematic data collection of selected symptoms among yatris and their surveillance through tablet could be established during the panchkroshi yatra, which can complement the existing surveillance for detecting early warning signals. We recommend the implementation of such tablet-based surveillance during such mass gathering events.
Background: The aim of this study was to evaluate the diagnostic potential of immunohistochemistr... more Background: The aim of this study was to evaluate the diagnostic potential of immunohistochemistry using an antibody to the secreted mycobacterial antigen MPT64, in abdominal and lymph node tuberculosis. Methods: We used formalin-fixed histologically diagnosed abdominal tuberculosis (n = 33) and cervical tuberculous lymphadenitis (n = 120) biopsies. These were investigated using a combination of Ziehl-Neelsen method, culture, immunohistochemistry with an antibody to MPT64, a specific antigen for Mycobacterium tuberculosis complex organisms. Abdominal and cervical lymph node biopsies from non-mycobacterial diseases (n = 50) were similarly tested as negative controls. Immunohistochemistry with commercially available anti-BCG and nested PCR for IS6110 were done for comparison. Nested PCR was positive in 86.3% cases and the results of all the tests were compared using nested PCR as the gold standard. Results: In lymph node biopsies, immunohistochemistry with anti-MPT64 was positive in 96 (80%) cases and 4 (12.5%) controls and with anti-BCG 92 (76.6%), and 9 (28%) respectively. The results for cases and controls in abdominal biopsies were 25 (75.7%) and 2 (11.1%) for anti-MPT64 and 25 (75.7%) and 4 (22%) for anti-BCG. The overall sensitivity, specificity, positive and negative predictive values of immunohistochemistry with anti-MPT64 was 92%, 97%, 98%, and 85%, respectively while the corresponding values for anti-BCG were 88%, 85%, 92%, and 78%. Conclusion: Immunohistochemistry using anti-MPT64 is a simple and sensitive technique for establishing an early and specific diagnosis of M. tuberculosis infection and one that can easily be incorporated into routine histopathology laboratories.
Background: The global expansion of antibiotic-resistant bacteria is a serious concern and is inc... more Background: The global expansion of antibiotic-resistant bacteria is a serious concern and is increasing worldwide in both pathogenic and commensal bacteria. The study determined the correlation between individual child-level antibiotic consumption and antibiotic resistance among the commensal Escherichia coli (E.coli) in a cohort of 125 children in rural Ujjain, India. Methods: During a two-year period between August 2014 and September 2016, stool samples were collected at seven-time points from a cohort of 125 children; aged 1-3. A total of six colonies of E.coli per stool sample were collected for antibiotic susceptibility testing. Antibiotic consumption data was collected during the healthcare-seeking follow-up done during the same period. At each of the seven-time points correlation between antibiotic consumption (Defined Daily Dose-DDD/100 patient-days) and antibiotic resistance (number of resistant isolates) was analyzed independently using the Spearman correlation coefficient. Further, mixed-effects logistic regression models were built to study correlation between child-level consumption of penicillin with the number of E.coli isolates resistant to ampicillin, consumption of cephalosporin with resistance to cefotaxime and ceftazidime, consumption of fluoroquinolones with resistance to nalidixic acid and consumption of cotrimoxazole with resistance to cotrimoxazole. Results: Out of 756 illness episodes reported in 125 children 42% were with antibiotic prescriptions and reported a total antibiotic consumption of 55DDD/100 patient-days. The most common antibiotics used were cefixime (J01DD08;72 DDD/100patient/days) followed by ofloxacin (J01MA01;51DDD/100patient-days), cefpodoxime (J01DD13;38DDD/100patient-days) and amoxicillin (J01CA04;28DDD/100patient-days). The highest percentage of resistance was found to the ampicillin (67%) followed by nalidixic acid (52%) and cefotaxime (44%) and when summarized, more than 90% were resistant to cefotaxime, ceftazidime, and cotrimoxazole in commensal E.coli isolates. The consumption of cephalosporins showed weak positive correlation with the resistance to cefotaxime (Coefficient±SE=0.13 ± 0.09,p<0.001). Conclusion: Our findings showed no correlation between individual-level antibiotic consumption and resistance development in commensal E.coli in a rural community environment.
International Journal of Environmental Research and Public Health, Jun 15, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background: Segregation of household waste at the source is an effective and sustainable strategy... more Background: Segregation of household waste at the source is an effective and sustainable strategy for management of municipal waste. However, household segregation levels remain insufficient as waste management approaches are mostly top down and lack local support. The realisation and recognition of effective, improved and adequate waste management may be one of the vital drivers for attaining environmental protection and improved health and well-being. The presence of a local level motivator may promote household waste segregation and ultimately pro-environmental behaviour. The present cluster randomized control trial aims to understand if volunteer based information on waste segregation (I-MISS) can effectively promote increased waste segregation practices at the household level when compared with existing routine waste segregation information in an urban Indian setting.
The Internet journal of ophthalmology & visual science, 2009
Introduction: Mycotic ulcer is common in rural, remote, agricultural regions of India, where prim... more Introduction: Mycotic ulcer is common in rural, remote, agricultural regions of India, where primary medical facilities are lacking. Diagnosis of causative fungus is usually not possible on the basis of available clinical and laboratory tests so the magnitude of mycotic keratitis is underestimated as a factor of corneal blindness. Purpose: To know the incidence of mycotic keratitis among the all corneal blindness cases along with predisposing factors, Setup: Tertiary Care Center (Medical college hospital). Material and Methods: We have included in the present study 201 consecutive cases of corneal ulcer attended hospital during April 2006 to November 2007. Diagnosis of mycotic keratitis was confirmed by history, clinical examination, direct microscopic examination of corneal scraping from the edge of ulcer for fungal hyphae and culture of fungus of corneal scraping and pus from anterior chamber, in different culture medias. Results: 42 cases (20.9%) of fungal corneal ulcer were found to be positive by direct examination and / or by culture. Fungal hyphae were seen by wet mount KOH preparation in 34 (80.9%) and culture growth present in 37 (88.0%) cases. Patients who have both test positive were 31(73.8%). Out of 34 culture grown 23 (54.7%) had pure fungal growth while 14(45.3%) showed fungus with superadded bacterial infections. Aspergillus fumigatus was the commonest causal agent isolated from 12 cases (5.9%) followed by in order to frequency are Aspergillus flavus (3.9 %), Candida (4.48 %), Curvularia (2.98 %), Penicillium (2.49 %) and Fusarium species (1.0 %). Conclusion: This study suggests that in all cases of corneal ulcer, corneal scraping is mandatory for early diagnosis of mycotic keratitis to prevent corneal blindness as there is a high incidence (20.9%) particularly in tropical agricultural regions.
et al. Determinants and pathways of healthcareseeking behaviours in under-5 children for common c... more et al. Determinants and pathways of healthcareseeking behaviours in under-5 children for common childhood illnesses and antibiotic prescribing: a cohort study in rural India. BMJ Open 2021;11:e052435.
International Journal of Environmental Research and Public Health, Apr 6, 2017
Antibiotic-resistant bacteria are an escalating grim menace to global public health. Our aim is t... more Antibiotic-resistant bacteria are an escalating grim menace to global public health. Our aim is to phenotype and genotype antibiotic-resistant commensal Escherichia coli (E. coli) from humans, animals, and water from the same community with a 'one-health' approach. The samples were collected from a village belonging to demographic surveillance site of Ruxmaniben Deepchand (R.D.) Gardi Medical College Ujjain, Central India. Commensal coliforms from stool samples from children aged 1-3 years and their environment (animals, drinking water from children's households, common source-and waste-water) were studied for antibiotic susceptibility and plasmid-encoded resistance genes. E. coli isolates from human (n = 127), animal (n = 21), waste-(n = 12), source-(n = 10), and household drinking water (n = 122) carried 70%, 29%, 41%, 30%, and 30% multi-drug resistance, respectively. Extended spectrum beta-lactamase (ESBL) producers were 57% in human and 23% in environmental isolates. Co-resistance was frequent in penicillin, cephalosporin, and quinolone. Antibiotic-resistance genes bla CTX-M-9 and qnrS were most frequent. Group D-type isolates with resistance genes were mainly from humans and wastewater. Colistin resistance, or the mcr-1 gene, was not detected. The frequency of resistance, co-resistance, and resistant genes are high and similar in coliforms from humans and their environment. This emphasizes the need to mitigate antibiotic resistance with a 'one-health' approach.
Background: Brucellosis is the most common zoonotic disease caused by Gram-negative coccobacillus... more Background: Brucellosis is the most common zoonotic disease caused by Gram-negative coccobacillus belonging to genus Brucella. It is a recognized public health problem in developing countries including India. Aims and Objectives: The aims of these study were to determine the seroprevalance of brucellosis in population having occupation dealing with animals and thus are in close contact of animals. Materials and Methods: The study was conducted in semi-urban areas of central India. Blood samples were collected from personnel working in slaughter houses, meat shops, and veterinarians and their close contact and who are willing to participate in study. A total 102 samples collected randomly from butchers (n=20), veterinarians (n=29), and animal handlers (n=53) and were tested for Brucella abortus and Brucella melitensis by a commercial kit which allows the detection of both complete (IgG and IGM) and incomplete antibodies. Results: A total 102 subjects were included in the study and overall prevalence of brucellosis among high-risk group was found to be 2.9%. One veterinarian doctor was also found positive for both B. melitensis and B. abortus. Highest prevalence of brucellosis was found in veterinarians (6.8%) followed by animal handlers (1.8%), and none of the butcher was tested positive for any of the Brucella antibody. Conclusion: The present study screened all possible known high-risk groups for brucellosis and revealed that veterinarians have high chances of getting the infection. Occupation-related disease like brucellosis needs regular surveillance and integration into control and prevention program at a local and national level.
Increasing generation of wastewater and its indiscriminate disposal is detrimental to human and a... more Increasing generation of wastewater and its indiscriminate disposal is detrimental to human and animal health. Resource‐limited settings often struggle for efficient wastewater treatment systems owing to lack of funds and operational difficulties. Therefore, alternative treatment systems involving low expenditure and simplistic operations are need of the hour. Constructed wetlands are one such alternative that can efficiently remove variety of pollutants from wastewater. In this study, we have assessed the utility of constructed wetlands for treatment of hospital wastewater in Ujjain. An in‐house wetland system was designed and constructed using Typha latifolia and Phragmites karka. Results showed that wetland was efficient for removal of various physico‐chemical and biological contaminants, namely, biochemical‐oxygen‐demand (77.1%), chemical‐oxygen‐demand (64.9%), turbidity (68.3%), suspended‐solids (63%), total‐phosphorus (58.7%), nitrate‐nitrogen (33%), fecal coliforms (96.8%), and total coliforms (95.6%). Paired t test revealed that removal efficiencies for various parameters were significantly different among Phragmites, Typha, and control cells (p ≤ 0.05). Study also depicted that most of the bacterial isolates in inlet wastewater were selectively resistant to antibiotics (ciprofloxacin and sulphamethaxazole) as well and these isolates were also removed. Precisely, Typha was fairly suitable for antibiotic resistant bacteria removal. Thus, constructed wetlands were found to be one of the suitable options for wastewater treatment in resource‐limited settings.Practitioner Points Constructed wetlands are one of the suitable options for wastewater treatment in resource limited settings. These systems involve wetland vegetation, soil, and associated microbial assemblages to improve the water quality. Typha and Phragmites were found to be efficient for treating the hospital wastewater. Experiments showed that antibiotic resistant bacteria may also be removed through constructed wetland systems. Easy operation, cost effectiveness, and efficiency are important attributes.
Background Antibiotic resistance is one of the major global health emergencies. One potential sou... more Background Antibiotic resistance is one of the major global health emergencies. One potential source of dissemination of resistant bacteria is mass gatherings, e.g. mass bathing events. We evaluated the physicochemical parameters of water quality and the antibiotic resistance pattern in commensal Escherichia coli from river-water and river-sediment in pre-, during-and postmass bathing events in river Kshipra, Central India. Method/Design Water and sediment samples were collected from three selected points during eight mass bathing events during 2014-2016. Water quality parameters (physical, chemical and microbiological) were analyzed using standard methods. In river water and sediment samples, antibiotic susceptibility patterns of isolated E. coli to 17 antibiotics were tested. Results pH, turbidity and dissolved oxygen were significantly lower and total dissolved solid, free carbon dioxide were higher during mass bathing, whilst TSS, BOD and COD were lowest in pre-bathing and highest in post-bathing period. E.coli with multi drug resistance (MDR) or extended spectrum beta-lactamase (ESBL) production were between 9-44% and 6-24%, respectively in river-water as well as river-sediment. Total coliform count/ml and E. coli count were higher during-and post-bathing in river water than in pre-bathing period. Thus, the percentage of resistance was significantly higher during and post-bathing period (p<.05) than in pre-bathing. Colony forming unit (CFU)/ml in river-sediment was much higher than in
Background Artesunate plus sulfadoxine-pyrimethamine (ASP) are first line treatment for uncomplic... more Background Artesunate plus sulfadoxine-pyrimethamine (ASP) are first line treatment for uncomplicated Plasmodium falciparum malaria in most of India, except for six Northeastern provinces where treatment failure rates were high. In Ujjain, central India, the frequency of mutations associated with increased drug tolerance, but not overt resistance to sulfadoxine and pyrimathamine were 9% and >80%, respectively, in 2009 and 2010, just prior to the introduction of ASP. The frequency of drug resistance associated mutations in Ujjain in 2015-2016 after 3-4 years of ASP use, are reported. Methods Blood samples from patients with P. falciparum mono-infection verified by microscopy were collected on filter-paper at all nine major pathology laboratories in Ujjain city. Codons pfdhfr 16-185, pfdhps 436-632 and K13 407-689 were identified by sequencing. Pfcrt K76T and pfmdr1 N86Y were identified by restriction fragment length polymorphism. Results Sulfadoxine-pyrimethamine resistance-associated pfdhfr 108N and 59R alleles were found in 100/104 (96%) and 87/91 (96%) samples, respectively. Pfdhps 437G was found in 10/105 (10%) samples. Double mutant pfdhfr 59R+108N were found in 75/81 (93%) samples. Triple mutant pfdhfr 59R + 108N and pfdhps 437G were found in 6/78 (8%) samples. Chloroquine-resistance-associated pfcrt 76T was found in 102/102 (100%). Pfmdr1 N86 and 86Y were identified in 83/115 (72%) and 32/115 (28%) samples, respectively. Conclusion The frequency of P. falciparum with reduced susceptibility to sulfadoxine-pyrimethamine remained high but did not appear to have increased significantly since the introduction of ASP. No polymorphisms in K13 associated with decreased artemisinin susceptibility were found. ASP probably remained effective, supporting continued ASP use. Background Malaria caused an estimated 9.6 million infections and 16 700 deaths in India in 2017. Approximately 12% (163 million) and 81% (1.1 billion) of Indians live in high and low malaria transmission areas, respectively. Only 7% (88 million) live in areas considered to be malaria-free. Malaria thus remains a major cause of morbidity and mortality and threatens the majority of the population [1]. Moreover,
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